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Uncommon cells in cerebrospinal fluid in Japanese encephalitis: A case report
Yuting Hou1,2, Xiao Yang2,3
1Department of Cerebrospinal Fluid Laboratory, The General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Rationale:
Cerebrospinal fluid (CSF) cytomorphology plays a critical role in the diagnosis of central nervous system infections. During an outbreak of Japanese encephalitis (JE) in Ningxia, China, an uncommon CSF cytomorphology in 1 case posed diagnostic challenges, highlighting the need to correlate cellular findings with clinical context for accurate interpretation.
Patient Concerns:
A 56-year-old female farmer from a JE-endemic village presented with fever, headache, dizziness, and nausea. Initial CSF cytological analysis revealed 2 uncommon cell types: type I cells, resembling siderophages, and type II cells mimicking malignant tumor cells.
Diagnoses:
JE was confirmed through JE virus-specific immunoglobulin G antibodies in both serum and CSF and genotype Ib identification. No evidence of cerebral hemorrhage or neoplastic meningitis was found. These 2 cell types disappeared during subsequent follow-up examinations.
Interventions:
Intravenous ganciclovir (300 mg, Q12H) was initiated promptly.
Outcomes:
Symptoms resolved within 1 week. At the 1-month follow-up, the patient recovered completely, confirming the JE diagnosis.
Lessons:
Transient uncommon CSF cells in this case of JE may exhibit morphological features resembling siderophages or malignant tumor cells, thus requiring a comprehensive correlation between cytomorphological findings and both clinical and laboratory data. This case highlights CSF cytology's diagnostic value in central nervous system infections while cautioning against overreliance on isolated cellular findings. Effective collaboration between clinicians and cytologists is essential to prevent misdiagnosis and ensure appropriate therapeutic guidance.
Insights
Uncommon cerebrospinal fluid cells in Japanese encephalitis (JE) can mimic other conditions, emphasizing the need for clinical correlation. Accurate diagnosis relies on integrating cytomorphology with laboratory and clinical data for effective treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Cytopathology
Background:
- Cerebrospinal fluid (CSF) cytomorphology is vital for diagnosing central nervous system (CNS) infections.
- An unusual CSF cell presentation during a Japanese encephalitis (JE) outbreak posed diagnostic challenges.
Purpose of the Study:
- To report a case of Japanese encephalitis (JE) with uncommon cerebrospinal fluid (CSF) cytomorphology.
- To highlight the importance of correlating CSF cellular findings with clinical and laboratory data for accurate diagnosis.
Main Methods:
- A 56-year-old female presented with symptoms suggestive of JE.
- CSF analysis revealed two distinct cell types: type I (siderophage-like) and type II (tumor cell-like).
- JE was confirmed serologically and by viral genotyping; treatment with ganciclovir was initiated.
Main Results:
- The patient experienced symptom resolution within one week and complete recovery within one month.
- The uncommon CSF cell types resolved during follow-up.
- No evidence of cerebral hemorrhage or neoplastic meningitis was found.
Conclusions:
- Transient, uncommon CSF cells in JE can present with morphology mimicking siderophages or malignant cells.
- Accurate diagnosis requires comprehensive correlation of cytomorphology with clinical and laboratory data.
- This case underscores the diagnostic value of CSF cytology in CNS infections and the necessity of interdisciplinary collaboration to prevent misdiagnosis.
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